The prognostic impact of M-CSF, CSF-1 receptor, CD68 and CD3 in prostatic carcinoma.

AIMS: Macrophage colony-stimulating factor (M-CSF) binds to colony-stimulating factor-1 receptor (CSF-1R) and stimulates proliferation and differentiation of monocytes, macrophages and their bone marrow progenitors. M-CSF, CSF-1R, the macrophage marker CD68, and the pan T-lymphocyte marker CD3 are increased in many human cancers. Their prognostic importance in primary prostatic carcinoma has not been fully delineated. The aim was to compare the expression of M-CSF, CSF-1R, CD68 and CD3 in metastatic and non-metastatic prostatic cancer. METHODS AND RESULTS: Digital video analysis of tumour cell areas and tumour stromal areas was performed in 59 cancer specimens: 32 patients with metastases and 27 patients without metastases. Expression of M-CSF and CSF-1R was recorded as 0 (negative immunoreactivity), 1 (weak), 2 (moderate) or 3 (strong reactivity). Macrophages (CD68) and T lymphocytes (CD3) were detected as proportions of moderately or strongly immunoreactive cells. Patients with metastatic primary cancers showed higher expression of M-CSF (P < 0.0001, P = 0.005), CSF-1R (both P < 0.0001) and CD3 (P = 0.007, P < 0.0001) in both tumour cell areas and tumour stromal areas, compared with the non-metastatic cancers. CONCLUSION: This study suggests that expression of M-CSF, CSF-1R and CD3 is a significant prognostic factor in primary prostatic cancers by predicting the development of metastases.

Surviving extreme hypercalcaemia--a case report and review of the literature.

We report a case of extreme hypercalcaemia associated with a parathyroid adenoma in a young man. The patient presented with classical symptoms of a hypercalcaemic syndrome, and serum calcium and parathyroid hormone levels were 6.92 mmol L(-1) and 70.2 pmol L(-1) respectively. After stabilizing the patient and reducing the calcium level, a parathyroidectomy was performed. The postoperative course was uneventful with rapidly resolving clinical symptoms. Hypercalcaemic crisis is a rare but life-threatening complication of primary hyperparathyroidism. It should be suspected in acutely ill patients complaining of muscular weakness, gastrointestinal and cerebral symptoms. To reduce mortality, it is essential to correctly diagnose the condition without delay and provide appropriate emergency management correcting hypercalcaemia and dehydration. Successful parathyroidectomy quickly relieves symptoms and prevents recurrence.

Goserelin (Zoladex) or orchiectomy in metastatic prostate cancer? A quality of life and cost-effectiveness analysis.

BACKGROUND: We have today two treatment alternatives (orchiectomy or LHRH-analogue) in metastatic prostate cancer offering the same expectations of survival. This study documents the quality of life (QoL) and cost-effectiveness of these alternatives. PATIENTS AND METHODS: 65 consecutive patients treated at the University Hospital of Tromsø (UHT), Norway, between 1994 and 1999 were registered. At evaluation, 45 patients (LHRH-analogue--15 patients, orchiectomy--30 patients) were alive and included in the QoL-study (EORTC QLQ C-30, QoL 15D). 45 patients were followed-up at the UHT and included in the cost-analysis. Costs were calculated for a 36-month interval and converted to British pounds (1 Pound = 13 NOK). A 5% d.r. was employed. RESULTS: The mean QoL (15D) was 76.4 (orchiectomy) and 72 (LHRH) (0-100 scale). Constipation, urinating problems, fatigue, pain and loss of sexual functioning were the dominant symptoms. The treatment costs per patient treated were 8,895 Pounds (orchiectomy) and 10,937 Pounds (LHRH-analogue). The crossover in cost was located at 25 months. A sensitivity analysis varying discount rate (0-10%), drug charges (25-50% off) and treatment time (12-18 months) did not alter the conclusion. CONCLUSION: Orchiectomy is the treatment of choice when life expectancy is more than two years.

[A new minimally invasive surgical method for stress incontinence in women]. / Ny og minimalt invasiv operasjonsmetode ved stressinkontinens hos kvinner.

Present surgical methods in the treatment of female urinary incontinence require relatively extensive surgery and several days in hospital. 84 consecutive patients (age 34-78 years) with proven stress incontinence were operated with the new tension-free vaginal tape procedure (TVT) and studied prospectively from November 1996 to August 1998. The operation was carried out under local anaesthesia, a procedure which allows the surgeon to check during the operation that continence is achieved. 52 patients (62%) were discharged from the hospital the same day. After four months, 79 out of 82 patients (96%) were cured or had improved considerably. No serious complications occurred. Four patients experienced various degrees of retention. The tension-free vaginal tape method seems to be an effective minimal invasive surgical procedure for the treatment of female stress incontinence. However, randomized controlled studies and long term follow-up are needed for a more complete evaluation of its merits versus the Burch colposuspension which is considered the "gold standard".

Focal xanthogranulomatous pyelonephritis presenting as renal tumour in children. Case report with a review of the literature.

Xanthogranulomatous pyelonephritis (XGP) is a specific form of chronic inflammatory kidney disease which may involve both sexes at any age. The disease presents either in the diffuse form or less commonly as a focal process which is almost impossible to differentiate from renal malignancy. XGP usually occurs in association with urinary tract obstruction, infection and/or renal stones. Symptoms are often vague and non-specific. The most common offending organisms are E. coli and Proteus mirabilis. In reviewing the literature we have found 197 cases in children during the last thirty years, and of these only 15 (7.6%) were of the focal form. A case of focal xanthogranulomatous pyelonephritis in a 6-year-old boy is reported which demonstrates the diagnostic difficulties encountered in this disease. We emphasize the importance of XGP in the differential diagnosis of renal tumours in children with recurrent or therapy-resistant urinary tract infection in spite of no evidence of renal stone, poorly or absent function in the kidney or urinary tract obstruction.

Inherited breast carcinoma--prospective findings in 1,194 women at risk.

According to preset criteria, 1,194 women at risk for inherited breast carcinoma were selected and subjected to examination. Six hundred and three women were examined once, 591 were followed for a mean of 1.8 years. Twenty infiltrating cancers (median age 49 years) and 16 precancers (median age 44 years) were found, demonstrating that breast carcinoma continued to occur in the selected families as expected under the hypothesis of dominant inheritance. At first round, 14 (1.2%) infiltrating carcinomas and a total of 22 (1.8%) cancers or precancers were found. Incidence rates of 0.58% pr. year for infiltrating cancers, and 1.04% pr. year for cancer or precancer were calculated. This confirms the tentative conclusions that were drawn in our previous report. These are the first prospective reports documenting how to delineate a high risk group for premenopausal breast cancer, and how to diagnose cancer at an early stage. All but two affected women had cancer without lymph node metastasis. Although a longer observation time is needed, we cautiously conclude that the results are in keeping with our aim of providing safety for those at risk. Clinical use of predictive genetic testing may be implemented within these families.

[Testicular cancer treated at the regional hospital in Tromsø 1985-1993]. / Testikkelkreft behandlet ved regionsykehuset i Tromsø 1985-93.

The case histories of 98 patients (47 seminomas and 51 non-seminomas) treated at the Department of Oncology, University Hospital of Tromsø between January 1985 and March 1993 were retrospectively analysed in August 1994. The analysis was undertaken to ascertain whether a small centre can achieve state of the art results. Complete remission was achieved in all cases. During a four year median follow-up period (range 1-10 years), three seminomas and eight non-seminomas relapsed. Only one retroperitoneally located relapse was revealed after retroperitoneal lymph node dissection. Two patients (one seminoma, one non-seminoma) died of progressive disease. A statistically significant correlation was found between stage of disease and human chorionic gonadotropin, lactate dehydrogenate and alpha-fetoprotein in non-seminoma. Our results are similar to those of the major oncological centres. Hence our unit is able to achieve state of the art results in the treatment of testicular carcinomas.

Transurethral microwave thermotherapy for uncomplicated benign prostatic hyperplasia. A prospective study with emphasis on symptomatic improvement and complications.

A single session of transurethral microwave thermotherapy (TUMT) was used in 115 patients with symptomatic uncomplicated benign prostatic hyperplasia (BPH). Subjective symptoms and urodynamic parameters were assessed before treatment, at 6 weeks, 3, 6 and 12 months after treatment and complications recorded. There was significant improvement in obstructive, irritative and total symptom scores at all time intervals. The maximum and corrected flow rate improved significantly at all time intervals as well as the decrease in residual urine. Complications occurred in 45.2% patients with no mortality. The most frequent complications were urinary tract infection (32.1%) and urinary retention (28.6%). Two patients experienced retrograde ejaculation. No patient was hospitalized due to complication. Four (3.5%) patients required transurethral resection of the prostate during the follow-up period due to persistent symptoms; 96.5% have remained satisfied. In conclusion, TUMT is a promising treatment option in selected patients with BPH, is well tolerated and complications are easy to treat. Its main advantage is the fact that it can be administered on an outpatient basis, thus reducing patient inconvenience and costs.

[Brodie's abscess]. / Brodies abscess.

Brodie's abscess is a localized subacute or chronic osteomyelitis independent of any known previous acute infection. The entity is often mistaken for a bone tumour. The diagnosis requires biopsy. The treatment is curettage, drainage and antibiotics for a minimum of six weeks. We describe the characteristics of Brodie's abscess and describe a patient with an illustrating history, but with an unusual localization of the abscess (osilium).

[Transurethral microwave therapy of benign prostatic hyperplasia. Results after 1-year follow-up]. / Transurethral mikrobølgeterapi ved benign prostatahyperplasi. Resultater etter ett års oppfølging.

We describe the results after one year follow-up of the first 17 patients treated with transurethral microwave therapy at the University Hospital in Tromsø. We used the Prostatron (Technomed International), a microwave generator delivering heat to the prostate through a water-cooled transurethral catheter. After six weeks we recorded significant improvement in symptom score, residual urine and peak flow rate. There was continuous improvement in all recorded parameters until the last control 13 months after treatment, except in the case of symptom score, where the level was the same after 13 months as after six months. We found a high incidence of urinary tract infections after treatment, owing to liberal use of prophylactic transurethral catheters. In one patient we also recorded retrograde ejaculation as an adverse effect of treatment. To our knowledge this has not been reported earlier.

[Urinary tract infections. Views on microbiological diagnosis and resistance determination]. / Urinveisinfeksjoner. Synspunkter på mikrobiologisk diagnostikk og resistensbestemmelse.

Urinary tract infection is a common problem affecting every fifth woman during her life. Although the clinical diagnosis is easy, and is based mainly on symptoms and microscopy of urine sediment, the microbiological diagnosis is often difficult. Escherichia coli is the main etiologic agent, causing urinary tract infection in approximately 80% of the cases. Adherent, uropathogenic E coli strains are associated with pyelonephritis and relapse. Staphylococcus saprophyticus is a frequent cause of urinary tract infections in fertile women. The urethral syndrome, caused by several agents, is an important factor in differential diagnosis. Microscopy is the cornerstone of all diagnostics of urinary tract infections. A urine culture that is taken, handled, transported and interpreted satisfactorily can provide valuable information with respect to diagnosis, treatment, prophylaxis and epidemiology.

[Breast tumor--a diagnostic challenge]. / Tumor mammae--en diagnostisk utfordring.

The study includes all patients referred for surgical examination with suspected breast cancer (n = 439) during a single year. All women were examined clinically. Mammography was performed in 372 cases (88%), and 195 (46%) women underwent biopsy. 37 (8.7%) of the admitted women had breast cancer, which was verified by histological examination. This corresponds to an incidence rate of 0.8 per 1,000 women, and an incidence rate of 2.0 per 1,000 in women above 40 years. In four patients who were not suspected as having breast cancer after clinical examination, breast cancer was revealed by mammography. However, mammography alone is insufficient, since three mammograms were false negative, in cases where cancers were diagnosed clinically. Therefore, both mammography and clinical investigation are necessary in the examination of women with breast tumors. When breast cancer cannot be ruled out by physical and mammographic examination, a representative specimen of the tumor should be removed for histological or cytological examination.

[Osteitis fibrosa cystica von Recklinghausen]. / Osteitis fibrosa cystica von Recklinghausen.

We present the case of a woman with classical osteitis fibrosa cystica generalisata von Recklinghausen, caused by a single adenoma of the left inferior parathyroid gland. After six months with increasing bone pain, pathological fractures and cystic lesions radiologically, hyperparathyroidism was diagnosed by persistent elevated levels of serum calcium, and elevated levels of PTH. Surgical extirpation of the parathyroid adenoma caused a period with severe hypocalcemia followed by complete clinical restitution. The diagnosis should be considered in any case of persistent bone pain and uncharacteristic fatigue.

[Infantile hypertrophic pyloric stenosis. 22 years' data]. / Infantil hypertrofisk pylorusstenose. Et 22 års materiale.

The report is a retrospective study of the journals of 123 patients operated from 1967-89. In all patients, the Fredet-Ramstedt pyloromyotomy was used. The incidence of pyloric stenosis is stable in Tromsø, 1.5 +/- 1 pr. 1,000 newborn. The incidence among boys and girls is 4:1. Serious complications after surgical treatment are infrequent; with no mortality and 4% reoperations. The duration of symptoms significantly increased the incidence of peroperative pyloric perforations, with a more tedious postoperative course. Early diagnosis and surgical treatment are therefore recommended.

Injuries to the hand inflicted by rotary snowcutters.

In the period January 1, 1975, through December 31, 1986, 28 patients were treated for hand injuries caused by small home rotary snowcutters. These injuries were characterized by extensive lacerations and contusions, particularly on the dorsal side of the hand and the fingers, with concomitant extensor tendon ruptures, comminuted and complicated fractures, and traumatic amputations of fingers of the dominant hand. The index and middle finger were nearly always injured; the thumb was usually totally spared. The frequency of postoperative complications was low after delayed primary surgical treatment. In this series the mean permanent medical disablement was found to be 12%, ranging from 0 to 50%. The present observations, when made available, alarmed national authorities. In turn, manufacturers were required to equip rotary snowcutters with motorquenchers. This device will probably effectively prevent these injuries in the future.